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Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care
L Thomas1, M Fowler1, L Marsh1
1School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia.
Insights
Cervical arterial dissection (CeAD) is a common cause of stroke in young adults. A refined diagnostic tool aids early recognition, improving stroke prevention by guiding imaging referrals.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Tool Development
Background:
- Cervical arterial dissection (CeAD) is a primary cause of stroke in young adults, often presenting with symptoms mimicking musculoskeletal pain.
- Current diagnostic methods for CeAD are lacking, leading to missed diagnoses and delayed treatment.
- A validated diagnostic support tool is crucial for timely referral, monitoring, and stroke prevention.
Purpose of the Study:
- To validate a 4-criteria diagnostic support tool for early CeAD recognition in primary care.
- To refine tool descriptors and establish optimal cut-offs for clinical application.
- To improve the early detection of CeAD and facilitate appropriate patient management.
Main Methods:
- A prospective observational study involving adults over 18 with confirmed CeAD and controls with headache/neck pain.
- Participants were scored using criteria for acute onset pain, trauma/infection, neurological features, and age.
- The initial tool's diagnostic values were analyzed, and the tool was refined based on performance metrics.
Main Results:
- The initial tool showed excellent prediction (AUC 0.83) but poor specificity.
- A refined tool (scored out of 4) demonstrated 100% sensitivity and 74% specificity for CeAD detection (AUC 0.87).
- The refined tool's optimal cut-off was determined to be 3/4 for recommending vascular imaging.
Conclusions:
- The refined 4-criteria tool exhibits acceptable clinical utility for CeAD detection at a cut-off of ≥3.
- The tool can guide the recommendation for urgent vascular imaging in primary care settings.
- Further validation in emergency departments and primary care is warranted to confirm its clinical utility.
Background:
Cervical arterial dissection (CeAD) is a leading cause of stroke in young adults with an early presentation often mimicking musculoskeletal pain. Currently, no validated tests exist and CAD may be missed. A diagnostic support tool could help guide urgent referral for imaging, when to monitor, or when safe to proceed with treatment, and ultimately help stroke prevention.
Objectives:
To validate a 4-criteria diagnostic support tool for early recognition of CeAD in primary care, to refine tool descriptors as needed, and propose optimal cut-offs for clinical application.
Design:
Prospective observational study METHOD: Participants with radiologically confirmed CeAD and controls without CeAD were identified from adults >18 years presenting to a tertiary metropolitan hospital with initial diagnosis of headache or neck pain. All were scored with criteria out of7 (acute onset pain [2], recent trauma/infection [1], neurological features [2], age <55 years [2]). Diagnostic values were calculated to determine cut offs and the tool was refined based on the analysis.
Results:
Thirty participants with CeAD and 261 controls with non-CeAD causes of headache and neck pain were included. The diagnostic support tool was an 'excellent' predictor of CeAD (AUC 0.83) but demonstrated poor specificity. Refining the tool to 'acute/sudden onset' [1], 'unusual/unfamiliar headache/neck pain' [1], recent trauma/infection [1] and neurological features ≥2 [1], scored out of 4, showed 100 % sensitivity and 74 % specificity to detect CeAD at a cut-off of 3/4 (AUC 0.87).
Conclusions:
The refined tool shows acceptable clinical utility at a cut-off ≥3, where referral for vascular imaging is recommended. Further validation in Emergency and primary care is needed.
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